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Symptom Awareness

Difficulties with Swallowing

Swallowing problems can be a common symptom of MS. Also known as "dysphagia," swallowing dysfunction can greatly affect one's quality of life. Anyone experiencing swallowing issues should contact his or her physician. Patients with swallowing problems are usually referred to a speech-language pathologist (SLP) for a swallowing evaluation.

Prior to developing swallowing problems, most people don't realize the complexity involved with this function. Eating and swallowing are normally automatic and can be easily accomplished by the smallest of children. Yet it is an extremely involved process, requiring muscle tone, coordination, and signals from the nerves to instruct the parts of the mouth with how to handle different types of food.

The swallowing process begins with recognizing the food, detecting its texture and taste. When the food enters the mouth, oromotor control is needed to close the lips, holding in the food while breathing through the nose. Facial tone helps keep the food in place. Coordinated jaw and tongue motion is used to chew the food and reduce it to a consistency that will be comfortable and safe to swallow. Most foods are formed into a cohesive ball before it is moved quickly into the stomach. Along the way it must pass through the pharynx (back of the mouth) and the esophagus (tube that transports the food).

Meals are an important gathering time for the family. When a family member has problems swallowing, meals can become very stressful for everyone involved. Choking can frequently occur, and this is both frightening and dangerous. Choking occurs when food gets into the airways and lungs, and the first priority is to clear the airways so the person may breathe. This also carries the risk of pneumonia and infection, as food particles can remain.

In addition to choking, symptoms of dysphasia can include coughing, congestion, throat clearing, and gurgling sounds, particularly during or after a meal. Someone with swallowing issues may have trouble getting foods to move down the throat, and he or she may have a weaker voice when dealing with these problems. Anxiety and fear can often result. Over time, if the individual is not able to take in adequate calories and nutrition, he or she may experience weight loss and related health problems.

Swallowing requires four stages, each using different sets of muscles. These stages are: oral preparatory (chewing, changing the consistency, forming a ball of food); oral stage (tongue pushing the food to the back of the mouth); pharyngeal stage (initiates the swallowing action as food or liquid is moved to the beginning of the throat); and esophageal stage (food travels down the esophagus to the stomach). For some individuals, the food may not move along the route smoothly. It may stick in the throat or travel too slowly. Others may have trouble preparing the food for swallowing, or the swallowing reflex may not respond well.

Fortunately, help is available. By seeing an SLP, one's swallowing may be evaluated and specific trouble spots identified. An SLP will examine a patient's swallowing process using a videofluoroscopy. Using a dye, this procedure is similar to a moving X-ray, and different types of food are videotaped as it is chewed and swallowed. Once the specific problem areas have been identified, a plan may be designed to enable the patient to safely get the nutrition that he or she needs.

Management plans can include changing the texture of the food, sometimes adding a thickening agent, and other times moistening food for smoother movement. Warming or cooling the food may help with the swallowing reflex. Other strategies can include alternating between liquid and solid food to keep things moving; reducing the size of each bite; and having smaller meals more frequently through the day, if needed. An SLP can give instruction for changing the position of the head and chin, and can also assign exercises to make swallowing easier.

Meals should be a time of both social enjoyment and nutrition, while safety needs to be the top concern. Family members should be familiar the Heimlich Maneuver; for instructions, readers may visit www.heimlichinstitute.org. For a list of references or to speak with a Helpline consultant, please call MSAA at (800) 532-7667. Anyone experiencing swallowing issues should contact his or her physician.